Gastrointestinal manifestations and acute abdominal pain of childhood systemic lupus erythematous / 中华实用儿科临床杂志

ABSTRACT

Objective To analyze the clinical characteristics of childhood systemic lupus erythematosus (SLE) patients with severe gastrointestinal manifestations,especially cases with acute and severe abdominal pain,so as to improve the recognition of severe and acute gastrointestinal manifestations of SLE during pediatric diagnosis and treatment.Methods Medical records of 119 patients with SLE under the age 16 years old in Peking Union Medical College Hospital from Jan.2010 to Mar.2013 were reviewed and gastrointestinal manifestations were retrospectively analyzed.All patients were diagnosed as SLE according to 1997 American College of Rheumatology (ACR) revised classification criteria.Results Gastrointestinal involvement was recorded in 24 children (20.2％).The median (range) age at the time of initial gastrointestinal manifestations was (13.5 ± 2.0) years (6-15 years).The ratio of female to male was 1.0 ∶ 2.4.And in 4 cases,gastrointestinal manifestations occurred as the initial symptoms.Abdominal pain was the most frequent symptom,present in 13 patients (54.2％),11 cases (45.8％) had nausea and vomiting,4 cases (16.6％) had abdominal distension,and 3 cases (12.5％) had diarrhea.Abnormal liver function was found by lab test in 8 cases,without obvious symptoms or the proofs of any virus infection.Acute and severe abdominal pain was found in 9 cases,of whom 6 patients were diagnosed as intestinal pseudo-obstruction (2 cases with bilateral ureterohydronephrosis),1 case had acute peritonitis with surgery,1 case was diagnosed as protein losing enteropathy and 1 case had acute pancreatitis.Liver impairment also occurred in SLE.All cases got alleviated with the treatment of steroids and immunosuppressive drugs.Significant difference was found in the occurrence of hydroureter and hydronephrosis and albumin concentrations between SLE digestive and non-digestive system involvement children.However,there was no remarkable difference in the erythrocyte sedimentation rate,or the involvement of kidney and blood system and central nervous system between the 2 groups.Conclusions SLE is a common autoimmune disease in children involving multiple systems.The severity of gastrointestinal involvement is underestimated.Gastrointestinal manifestations can be initial symptoms of SLE.Intestinal pseudo-obstruction,protein losing enteropathy,and acute pancreatitis are uncommon but severe gastrointestinal manifestations of SLE patients should be fully recognized.It is vital for pediatric physicians to make early diagnosis and begin timely treatment on SLE with Corticosteroid and cyclophosphamide.